Healthcare Provider Details

I. General information

NPI: 1033305222
Provider Name (Legal Business Name): MONICA MARTINEZ VIGIL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORNELL BUILDING 73 ROOM 21
ALBUQUERQUE NM
87131-5904
US

IV. Provider business mailing address

300 CORNELL BUILDING 73 ROOM 21
ALBUQUERQUE NM
87131-5904
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-6306
  • Fax: 505-277-0286
Mailing address:
  • Phone: 505-277-6306
  • Fax: 505-873-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNM5567
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: